Thursday, February 24, 2022

Racial Disparities Persist in Ovarian Cancer

This article appeared on the Clearity Foundation web site and was written by Jon Kelvey

Black patients with ovarian cancer were less likely than their White counterparts to receive adjuvant chemotherapy after primary surgery, according to a study published in Gynecologic Oncology.

The study also showed that patients who did not undergo adjuvant chemotherapy had worse survival outcomes.

For this study, researchers analyzed National Cancer Database data on patients with stage II-III ovarian cancer who underwent primary surgery.
Of the 48,245 patients, 42,914 were White, 3058 were Black, and 2273 were another race. The patients’ median age was 61 years. There were 522 patients (1.08%) who did not receive adjuvant chemotherapy due to clinician-identified risk factors

In a multivariate analysis, the following factors were associated with not receiving a recommendation for adjuvant chemotherapy — Black race, being older (≥70 years), having higher Charlson-Deyo comorbidity scores (>0), having government insurance (vs private insurance), and being treated at a community center (vs academic/research center).

When controlling for all other factors, Black race was significantly associated with not being recommended chemotherapy (adjusted odds ratio, 2.12; 95% CI, 1.61-2.78; P <.0001).
Not being recommended for chemotherapy was associated with worse overall survival (OS). The median OS was 53.8 months for those who received adjuvant chemotherapy and 12.1 months for those who did not (adjusted hazard ratio [aHR], 2.74; 95% CI, 2.48-3.03; P <.0001).

OS outcomes were similar for Black and White patients who were not recommended for chemotherapy (aHR, 1.01; 95% CI, 0.74-1.39, P =.951).

Among Black patients, the 5-year OS rate was significantly higher for those who received a recommendation for chemotherapy than for those who did not — 40.3% and 25.9%, respectively (P <.0001).

The researchers noted that, of the 62 Black patients who were deemed too high risk to receive chemotherapy, 31 patients had a risk profile similar to the profiles of White patients who did receive chemotherapy.

These results suggest that risk estimation may be performed unequally on the basis of race. However, due to limitations of the data studied, the researchers could not rule out that other factors might help explain the observed disparity. One limitation is that functional status is not included in National Cancer Database records.

“Additional research is warranted to directly investigate the role of bias, including implicit bias, in clinical decision-making in gynecologic oncology,” the researchers concluded.

Matthews BJ, Qureshi MM, Fiascone SJ, et al. Racial disparities in non-recommendation of adjuvant chemotherapy in stage II-III ovarian cancerGynecol Oncol. 2022;164(1):27-33. doi:10.1016/j.ygyno.2021.10.090

This article was published by Cancer Therapy Advisor.


Tuesday, February 22, 2022

Cervical Cell May Hold to Predicting Ovarian Cancer Risk


The Ovarian Cancer Research Alliance (OCRA) recently reported on this interesting study that was published in the journal Nature.

Cervical cell samples that are routinely collected as part of Pap smears may hold promise for predicting the risk of ovarian and other cancers, according to recent findings published as two separate papers in Nature — one focused on ovarian cancer and the other on breast cancer.

The researchers studied cervical samples collected at 15 different health centers in Europe from approximately 3,000 women — some with ovarian cancer, some with breast cancer, and some without either disease. The cervical cells were analyzed for specific “epigenetic footprints” that are associated with higher risk of ovarian or breast cancer, according to the scientists. 

“Our studies have taken a completely novel approach and evaluate an individual’s risk for more than one cancer by assessing several different epigenetic footprints in a single cervical screening sample,” said lead researcher Dr. Martin Widschwendter of University College London, University of Innsbruck, and the European Translational Oncology Prevention and Screening Institute.

These “epigenetic footprints” are identified by looking at chemical modifications or marks to the cell’s DNA that occur via a process known as DNA methylation. These marks tell the cell how to read the DNA and act on it. But both environmental factors and lifestyle habits can alter these marks in a way that is damaging to how the cell behaves, which the researchers believe may lead to increased cancer risk in some cases. The tests that they have developed, which are named WID for Women’s risk IDentification, involve the use of an algorithm that has been trained to spot specific patterns in DNA methylation marks that correlate to an increased risk of ovarian or breast cancer.

“Importantly, the tests do not detect actual cancer but rather indicate genetic, lifestyle and environment risk factors associated with them and may be able to predict future risk,” according to a statement from The Eve Appeal, which co-funded the study. 

The findings may pave the way for future screening tools, but more research is needed. The scientists plan to use large population trials to see whether the newly developed tests accurately predict cancer before it occurs. 
“As with any new test, they will need trialing on a large number of the population over the next years before being available widely,” said Dr. Chiara Herzog of University of Innsbruck and the European Translational Oncology Prevention and Screening Institute, who is a part of the research team. “Our next research will also discover whether the tests are best suited for screening all women and people with a cervix, or only in those with a known increased risk of these cancers (e.g., people with a BRCA alteration or family history).” 

Tuesday, February 15, 2022

Virtual Surveillance Visits with Symptom and Serum CA 125

This article by Monica Janke, MD, first appeared on OncLive.

In patients with ovarian cancer and pretreatment elevated CA-125 who achieved remission after frontline therapy, most recurrences are detected by rising CA-125 levels or symptoms.

In patients with ovarian cancer and pretreatment elevated CA-125 who achieved remission after frontline therapy, most recurrences are detected by rising CA-125 levels or symptoms, according to Monica Janke, MD. As such, virtual surveillance visits with review of symptoms and serum CA-125 may offer a reasonable alternative to in-person visits requiring a physical exam.1

Data from a retrospective study examining the utility of symptom review, serum CA-125, and physical exam in the detection of disease recurrence, showed that 42.2% of patients had suspected recurrence based on several modalities, 89.0% had elevated CA-125 at the time of their recurrence, and 93.6% of patients had elevated CA-125 and/or symptoms present at the time of recurrence. Notably, 96.3% of those who had abnormal physical exam findings also had elevated CA-125 or symptoms present at the time of their recurrence.

“The rapid implementation of telemedicine in the COVID-19 pandemic motivated us to examine the utility of ovarian cancer recurrence detection methods, most particularly the physical exam,” Janke said. “[In our analysis,] we wanted to try to answer of the question of what we might be missing if unable to perform physical exam. It seems that in this specific group of patients at our institution, physical exam may not add a substantial amount of value when there are alternative modality tools available, including symptom review and serum CA-125, which can be reviewed virtually with patients. This opens a door for us; it may be possible to see ovarian cancer surveillance going virtual in some way, shape, or form.”

In an interview with OncLive® during the 2022 SGO Winter Meeting, Janke, a third-year resident, Obstetrics and Gynecology, at Rogel Cancer Center, Michigan Medicine, University of Michigan, discussed the potential role of, or opportunity for, virtual surveillance care for patients with ovarian cancer in the midst of the COVID-19 pandemic and beyond.

Friday, February 11, 2022

Could Pap Smears One Day Help Detect Breast and Ovarian Cancers?


This article was written by Angus Chen, and appeared on the

New research suggests that cervical cancer screenings could be used to pick up on a patient’s risk of breast, ovarian, and endometrial cancers.

Routine screenings have become a powerful tool in catching cervical cancer as early as possible. Now, research suggests the cervical cells collected during these exams could hold the key to efficient screening for other gynecological cancers, too.
A new study suggests that by analyzing cervical cells’ genomes, researchers might be able to find genetic signatures that predict the risk of ovarian, breast, and endometrial cancers and flag patients that should be screened more aggressively. If the test proves useful in larger studies, it could offer a simple way to piggyback off of regular Pap smears already used to screen for cancerous or precancerous lesions in the cervix.

“One sample and then you could utilize this sample for predicting the risk for all four gynecological cancers: breast, ovarian, endometrial, and cervical cancer,” said Martin Widschwendter, a professor of cancer prevention and screening at Innsbruck University in Austria and a senior author on the study. “You want to make it easy. If it’s not convenient, then women likely won’t utilize it.”

The test looks for something known as methylation patterns in the genomes of cervical cells. Over the course of a lifetime, beginning in utero, a patient’s cells accumulate chemical modifications to their genomes. Unlike genetic mutations, these don’t change a cell’s genetic code but rather are like molecular “caps,” called methylations, that attach to the DNA and can turn certain genes on or off.
There are many factors that affect the pattern of DNA methylation in cervical cells including exposure to certain levels of chemicals or hormones like progesterone that can alter someone’s risk of cancer. In that sense, such changes in cervical cells might be a readout of a patient’s overall history that has an impact on cancer risk.

“Our idea was that these hormone-sensitive cells are recording these lifelong exposures in the epigenome,” said Widschwendter, who set out to find whether a specific signature in the cells could offer any clues about cancer risk.

He and his colleagues examined samples from cervical smears of roughly 2,000 women at 15 different health centers in Europe. Some of the women had ovarian or breast cancer, some were healthy, and some had a high suspicion of having ovarian or breast cancer but had not yet been diagnosed. The study didn’t disclose the full demographic breakdown of the cohort, but said an analysis suggested ethnicity — designated as white and non-white — did not seem to have an impact on the overall risk scores.

The team analyzed half of the samples and then used that data to train an algorithm to discover methylation signatures in the cervical cells that correlate with gynecological cancer risk.

Then, the researchers asked the algorithm to predict which patients in the other half of the database were at a high risk of gynecological cancer. When they stratified women into different risk groups, Widschwendter said that 70 to 75% of all ovarian and breast cancers could be found in the highest risk group. The team published their results in two papers in Nature Communications on Tuesday.

That suggests the analysis is able to accurately group patients by risk, said Shelley Tworoger, a cancer prevention researcher at the Moffitt Cancer Center. That could make a difference in developing better screening strategies to monitor women who are at the greatest risk. But, she added, it may be some time before the test yields much clinical utility on a large scale.

“Conceptually, I think this is a very interesting approach. Looking at methylation is a way we might be able to have an integrated view of the exposures a woman may have had in her lifetime that might affect her cancer risk,” she said. “It’s difficult to directly access [the ovaries or uterus] to identify cancer or precancerous lesions, so this might be a good way to identify people at high risk. Most women go in and get Pap smears so we already have this type of sample from women on a very regular basis.”

There are technologies to screen women for ovarian or endometrial cancer, including a blood test called CA 125 and ultrasound imaging. The problem with these methods, thus far, is that they haven’t been able to show that they can catch cancers at earlier stages when treatment has the best chance at success, Tworoger said. “But if we had women who we knew were at higher risk, maybe those screening modalities would work better and lead to better outcomes in them.”

But there’s still more work to be done before such a tool could be rolled out on a population-wide scale.  For one, Widschwendter used tens of thousands of genetic markers to generate usable methylation signatures that might indicate different cancer risks. “If they measured just 5 or 10 markers, it might be more straightforward,” Tworoger said. “It’s a lot more expensive to measure at this genome-wide scale than just a few markers. So, from a cost perspective, it might be prohibitive.”And algorithms trained and tested on one patient population – in this case, women treated at health centers in Europe – often do not perform as well on other patient populations. A tool that could be reliably used on a population level would need to include a far broader range of data.

Still, Tworoger said, the study helps open a new avenue of research looking more deeply into why methylations are related to cancer risk, and which might play the most significant role in predisposing someone to cancer.

“There’s the potential to learn more about the biology, and the more we understand, the better we can address the cancer either from a prevention or treatment side,” Tworoger said.

Friday, February 4, 2022

If You're Taking Doxorubicin - Read This

Doxorubicin, sold under the brand name of Adriamycin and Doxin, has been dubbed the "red devil" or "red death" by people who suffer from one of the common side effects of this medication: peeling skin on the hands and feet - a very painful condition. Doxorubicin is used to treat certain types of cancer including ovarian.

To deal with this, chemical and biomedical engineers at Penn State have developed nanoparticles that closely resemble hairy cellulose nanocrystals found in plants. These "hairs" are designed to essentially mop-up the excess drug limiting the exposure to healthy non-targeted tissue. This research is due to be published in the March issue of Materials Today Chemistry.

Amir Sheiki, one of the lead designers at Penn State had this to say about it:

"To the best of our knowledge, there is currently no nanoparticle-based super-capacity drug capture system," Sheikhi said, noting that the development of such a system could have significant impact on cancer treatment plans. "For some organs, like the liver, chemotherapy can be locally administered through catheters. If we could place a device based on the nanocrystals to capture the excess drugs exiting the liver's inferior vena cava, a major blood vessel, clinicians could potentially administer higher doses of chemotherapy to kill the cancer more quickly without worry about damaging healthy cells. Once the treatment is finished, the device could be removed."

The benefit is that higher doses of the medication can be given to patients to kill the cancer more quickly and effectively without worrying about damaging healthy tissues. Researchers found that for every gram of these hairy nanocrystals, 6,000 mg of Doxorubicin could be removed from human serum. 

To read more about this research follow this link to, a web-based science, research and technology news service that covers a wide range of topics.  

Tuesday, February 1, 2022

Patient Advocate Foundation

I'd like to thank Kelsey for letting us all know about this very important organization: Patient Advocate Foundation.

What is one of the most difficult areas to navigate in our health care system is trying to find the money to pay for the exorbitant cost of medications. Essentially, if one meets the criteria, PAF "...provides direct payment for co-pays, co-insurance and deductibles for patients who need financial assistance."

As I write this, the ovarian cancer co-pay relief fund is currently closed BUT - and I can not stress this enough - funds re-open often so it is important to check back frequently. Additionally, one can sign up to receive alerts when the fund re-opens. The funds for this rely on donors, so if you have the means to support this worthwhile organization, I would urge you to do so. Given that many of our dear women can not work while receiving treatment, this truly is a life saver for many.

Currently, the Cancer Genetic and Genomic Testing  and funds for Cervical Cancer are open. To sign up for alerts, please follow this link.